Abstract
Introduction
We investigated how the 2018 Organ Procurement and Transplantation Network heart allocation
policy change was associated with changes in characteristics and outcomes of candidates
receiving multiple temporary mechanical circulatory support (mtMCS) devices.
Materials and methods
We included adult heart transplant candidates listed October 2014-January 2018 and
October 2018-January 2022 in the United Network of Organ Sharing dataset. Prepolicy
and postpolicy mtMCS recipients were compared at listing, transplant, 90-days, and
1-year post-transplant. Time between first and second devices and time between first
device and transplant were modeled via multivariable linear regression. Transplantation
likelihood was modeled using competing risks analysis.
Results
Postpolicy, a higher proportion of transplant candidates received mtMCS (4% versus 1%, P < 0.001), and received their second device an adjusted 49 d sooner versus prepolicy (P = 0.001). Time to transplant was also an adjusted 35 d shorter postpolicy, with an
80% increased transplantation likelihood versus prepolicy (95% confidence interval: 1.6-1.9, P < 0.001). Postpolicy patients experienced reduced waitlist mortality (8% versus 14%, P = 0.04) with marked improvements in 90-day (93% versus 85%, P < 0.001) and 1-year (88% versus 70%, P = 0.01) post-transplant survival.
Conclusions
Postpolicy mtMCS recipients are more likely to progress to transplantation sooner
on the waitlist and their shorter waitlist course together with earlier change to
a secondary device was associated with improved post-transplant survival versus prepolicy.
Keywords
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Article info
Publication history
Published online: January 12, 2023
Accepted:
December 24,
2022
Received in revised form:
November 13,
2022
Received:
April 12,
2022
Identification
Copyright
© 2022 Elsevier Inc. All rights reserved.
